Analysis Of Clinical Related Factors Which Induce Postoperative Recurrence Of Glioma

As the most common intracranial malignant tumor, glioma has an overall incidence rate for about 12/10 million, accounting for about 40% of all kinds of intracranial tumors. Glioma (gliomas), also known as a kind of gliocytoma, which developed in neural ectoderm, also called neural ectoderm tumor or neural epithelium tumor. Mean survival time of high grade glioma after combined therapy is no more than one year, 2-year survival rate is only about 10%, the other different kinds or grade glioma are also difficult to cure, although noticeable improvement on tumor's neurosurgical treatment has been made in recent years, but the long-term glioma recurrence rate is still almost 100%, a poor prognosis. Different types of glioma patients receiving different treatment have a variant recurrence time and prognosis. At present, literature about the gliomas'recurrence time with the method of statistical analysis by tracking and follow-up investigation is very rare.Objective: Investigating the relevant factors which may influence the recurrence of glioma after surgical therapy, discuss and analysis those dates which have statistical significance, trying to find out risk and protective factors of glioma recurrence. With the current mainstream treatment norms for the treatment of glioma as reference, we could analyze and summarize the past glioma patients of our hospital, then to discuss and prospect the ever-changing new technologies, and therapies on giloma.Methods: Assembling the 146 cases glioma patients who were admitted in our hospital from December 2003 to December 2007,whose recent developments or first recurrence information could be obtained (those who still don't recur by now are not be included) , among which 16 cases have never surgical treatment, three cases of patients admitted to abandon the second surgery, that is, completly collecting 130 cases who have ever received operations in our hospital, diagnosised by postoperative pathology to be glioma tumor and recurred later. After medical records or follow-up we got the information included age, sex, the main symptoms, tumor location, size, extent of surgical resection, tumor grade, and recurrence from time form the first operation after chemotherapy and radiotherapy and so on, just the possible relevant factors which could change the recurrence process, analysis the dates with the cox regression analysis model of the software spss 13.0 for windows.Results:1. 130 cases of postoperative surgical patients had pathologically confirmed to be glioma patients. Patients with tumor site located in the right hemisphere are 52 cases, 58 cases happened in the left hemisphere. The main tumor location: frontal region of the cerebra, 46 cases, 30 patients in pars temporalis, and pars parietalis 15 cases, 10 cases in occipitalia, and cerebellar hemisphere and cerebellar vermis were 17 cases, the fourth ventricle and the other ventricle nine cases, three cases offended the corpus callosum, one case lied in the lumbar spine. The smallest anteroposterior diameter of tumor is 0.8cm and the largest is 9.0cm, the average size is 4.7cm. cases of partial resection is 29 patients, there are 28 cases whose glioma body bulk cut, total resection, 73 cases. Pathological analysis showed that there are 74 cases astrocytoma: including grade one 3, grade 1-2 2, grade 2 25, grade 2-3 16, grade three 17, grade 3-4 4, grade 4, seven. In the actual statistical analysis the mixed-level cases will be incorporated into the high-level group for computing, medulloblastoma and pleomorphic glioblastoma as grade four. Patients with radiotherapy alone, 37 people, only 11 were chemotherapy, people with therapeutic alliance of radiotherapy and chemotherapy, 14.2. After analyzing synthetically, we found that the radiotherapy,pathological grade,the patient's age and symptoms have statistical significance (P <0.05) but the other factors have no. what Needs to be pointed out is that patients who had or hadn't total tumor resection have a p-value of about 0.066, closer to 0.05, accounting the existence of the sampling error, and thus can not determine whether the extent of tumor resection is related or not, and the dummy variable 1 with p=0.024<0.05, to be considered should have some relevance in clinical patients. The pathological grade one's risk for a recurrence is 0.079 times to four, two to four times of 0.101, three to four times of 0.212, this showed that patients with higher tumor grade have greater risk of recurrence in short term. And those who didn't receive postoperative radiotherapy patients have a risk of recurrence 4.044 times than those who did. Note postoperative radiotherapy can effectively delay or prevent glioma's postoperative recurrence. Many clinical data suggest that postoperative chemotherapy or radio-chemotherapy for treatment of gliomas can effectively improve the prognosis of patients with glioma, prevent relapsing, and chemotherapy in this information associated with the recurrence have no statistical significance may be due to the samples of patients because of a small number of cases (25 cases, 19.2%) which caused a larger sampling error. The table suggests that age have statistical significance with recurrence, B=+0.21, OR=1.021, OR value and 95% confidence interval 1.006-1.037, showed that age have direct correlation with recurrent. A longer recurrence time followed by an older age, which may due to that relatively young age patients with a higher grade malignant tumors (such as medulloblastoma mostly happened in children or young people), and older patients have the low review rate, brain atrophy in old patients induced that recurrent tumors are significantly larg when detected, and other factors. Three dummy variables of Pathologic classification pathological dummy variable(1), dummy variable(2), dummy variable(3) B respectively -2.539, -2.289, -1.551, have the largest absolute value in all the variables groups. This shows that the pathology has the greatest impact on tumor recurrence in all the independent variable groups. And negatively correlated situation exists with the grade and the recurrence time. That is, the higher the levels of tumor are the shorter the time is.3. Treatment-related analysis on postoperative radio- chemotherapy between radiotherapy and chemotherapy alone: second cox regression analysis on combination therapy group associated offers the p-value 0.01, with the radio-chemotherapy group as benchmark, the radiotherapy group and the chemotherapy group alone respectively, OR=5.046 and OR=1.165, shows higher recurring risk of 5.046 and 1.165 times than radio-chemotherapy group, both were higher in relapse than radio-chemotherapy group. It shows that radio-chemotherapy has a more effective result in preventing or delaying the recurrence of cancer, which results in line with expectations, it also integrated with the current treatment of glioma advocated by most of doctors, that is, postoperative radio- chemotherapy.Conclusion: 1. Radiotherapy,pathological grade,the patient's age and symptoms have statistical significance (P <0.05) but the other factors have no. what Needs to be pointed out is that patients who had or hadn't total tumor resection have a p-value of about 0.066, closer to 0.05, accounting the existence of the sampling error. 2. Postoperative combined therapy, the data analysis shows that postoperative radiotherapy can effectively extend the time limit of tumor recurrence but chemotherapy did not. 14 cases radio-chemotherapy got into a third group, to compare with radiotherapy or chemotherapy alone group, meantime, pathological grade in consideration set for cox regression analysis, the results have statistical significances, recurring risk of radio-chemotherapy group is apparente lower that radiotherapy or chemotherapy alone. And the information referred that radio-chemotherapy can sensitizer the effect of drugs or radiorays, reinforced the therapeutic efficacy. 3. The patients with the cardinal symptom is epilepsia have a good prognosis than those onste with other symptoms, probably due to that those onset disease with epilepsia have a higher rate in getting a kind of tumor whose grade are relatively lower. Or because epilepsia customarily emerges at the earlier stage of tumor growth! It plays a key role in detecting gliomas, allowing patients to be treated as soon as possible. Strengthen the effect of surgical treatment.